Koscielniak-Nielsen Z J, Horn A
Department of Anesthesia, National University Hospital, Rigshospitalet, Copenhagen, Denmark.
Reg Anesth. 1994 Nov-Dec;19(6):402-7.
The aim of this study was to determine the optimal injection site for the intraarterial regional anesthesia for hand surgery.
Forty-two adult patients undergoing elective hand surgery were studied. 0.5% lidocaine plain 1.5 mg/kg was injected over 3 minutes into the radial artery (group 1), or the brachial artery (group 2) through a 22 or 20 gauge Teflon catheter.
Two patients (one in each group) were excluded due to technical problems. Onset of analgesia in the hand was faster after radial artery injection (P < .05). Onset of analgesia in the forearm was similar in both groups. Catheterization time, operating conditions, motor block, offset of analgesia, injection, surgical and tourniquet pain scores, and patient's acceptance were similar. Ten patients in group 1 and nine patients in group 2 needed supplemental analgesia at the start of surgery. Median nerve paresthesias were unintentionally elicited during catheterization in three patients in group 2. Six patients (two in group 1 and four in group 2) had minor systemic adverse effects after tourniquet release. Seven patients in group 1 and five in group 2 developed minor bruises after catheterization. No permanent sequelae of injections were observed.
Radial artery is preferred for intraarterial regional anesthesia. Compared with the brachial artery, injection in the radial artery produces faster analgesia in the hand and reduces the risk of damage to the median nerve.
本研究旨在确定手部手术动脉区域麻醉的最佳注射部位。
对42例择期进行手部手术的成年患者进行研究。通过22或20号聚四氟乙烯导管，将1.5mg/kg的0.5%单纯利多卡因在3分钟内注入桡动脉（第1组）或肱动脉（第2组）。
2例患者（每组各1例）因技术问题被排除。桡动脉注射后手部镇痛起效更快（P<0.05）。两组前臂镇痛起效情况相似。置管时间、手术条件、运动阻滞、镇痛消退、注射、手术及止血带疼痛评分以及患者接受度均相似。第1组10例患者和第2组9例患者在手术开始时需要追加镇痛。第2组3例患者在置管过程中无意引发了正中神经感觉异常。6例患者（第1组2例，第2组4例）在止血带松开后出现轻微全身不良反应。第1组7例患者和第2组5例患者在置管后出现轻微瘀斑。未观察到注射的永久性后遗症。
手部手术动脉区域麻醉首选桡动脉。与肱动脉相比，桡动脉注射可使手部镇痛起效更快，并降低正中神经损伤风险。
